AB1250 OUTPATIENT FOLLOW-UP AFTER AN EMERGENCY DEPARTMENT VISIT FOR ACUTE GOUT FLARE
Authors: L. Jackson, F. Mugeta, E. Mcneeley, N. C. Techarukpong, K. Aaron, J. Booth, J. Foster, G. Cutter, J. Osborne, K. Saag, M. Danila
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Patients with acute gout are frequently treated in the emergency department (ED). Appropriate outpatient follow-up for an acute flare after an ED visit is variable and has not been systematically examined. <h3>Objectives</h3> We aimed to determine the characteristics of patients with gout treated in EDs, the nature of their ED visits, and to determine the types and rates of outpatient follow-up after an ED visit for an acute gout flare. <h3>Methods</h3> This study was conducted at one academic medical center that serves patients at 3 EDs (2 urban, 1 suburban) and 1 urban urgent care center. Patients were identified as having a possible acute gout flare upon initial triage in the ED using a previously developed electronic medical record (EMR) gout flare alert. We validated the presence/ absence of an acute gout flare through manual EMR review using adjudicated expert consensus assessed with kappa coefficient as the gold standard. Among those patients identified with an acute gout flare, we abstracted their medical records to determine the presence/ absence of an outpatient visit for gout care within 6 months of the index ED visit. This was defined as having had a documented outpatient visit with any provider (e.g., primary care, rheumatology) with a mention of 'gout' in the free text portion of history of present illness or assessment and plan. We used descriptive statistics to characterize patients with gout and reported the proportion of patients with an acute gout flare that followed up in the outpatient setting after an ED visit. <h3>Results</h3> From September 1, 2021 to February 28, 2022, there were 458 patients identified by the gout flare alert as possibly having an acute gout flare. Of these, 33 patients were excluded from this analysis due to participation in an ongoing randomized clinical trial testing a behavioral intervention to improve gout care. The remaining 425 patients included 72 patients (16.9%) who were determined to have a true gout flare at 85 unique ED visits by manual EMR review by 2 assessors. The kappa coefficient for agreement between the consensus expert determinations of acute gout flare was 0.8. Of those with an acute gout flare, 53 (74%) were men and 49 (68%) were Black or African American. At ED discharge, a majority of patients (64%) were prescribed corticosteroids, while 63% were prescribed opioids. A majority (54%) of ED visits for acute gout occurred between 8am and 5pm, with another 27% occurring between 5pm and midnight. The proportion of patients with an acute gout flare who followed up with an outpatient clinician in our healthcare system was 46% (<b>Table 1</b>), with 29% of patients having an outpatient visit within 30 days of the index ED encounter. Only 26 patients (36%) had an outpatient visit addressing gout, and of these, 17 (24%) occurred within 3 months of the index ED visit. <h3>Conclusion</h3> More than half of patients received opioids at discharge among patients with gout treated in the ED, who were mostly Black. Follow-up was ~46% among patients that received gout care in an acute setting, yet only a third saw a clinician who addressed gout. This data will inform sample size calculation for interventional studies testing behavioral interventions focused on promoting improved outpatient follow-up for gout flares. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Lesley Jackson: None declared, Faith Mugeta: None declared, Ellen McNeeley: None declared, Norma C. Techarukpong: None declared, Kiara Aaron: None declared, James Booth: None declared, Jeff Foster: None declared, Gary Cutter Consultant of: Alexion, Antisense Therapeutics, Biogen, Clinical Trial Solutions LLC, Entelexo Biotherapeutics, Inc., Genzyme, Genentech, GW Pharmaceuticals, Immunic, Immunosis Pty Ltd, Klein-Buendel Incorporated, Merck/Serono, Novartis, Perception Neurosciences, Protalix Biotherapeutics, Regeneron, Roche, SAB Biotherapeutics. Data and Safety Monitoring Boards: Applied Therapeutics, AI therapeutics, AMO Pharma, Astra-Zeneca, Avexis Pharmaceuticals, Biolinerx, Brainstorm Cell Therapeutics, Bristol Meyers Squibb/Celgene, CSL Behring, Galmed Pharmaceuticals, Green Valley Pharma, Horizon Pharmaceuticals, Immunic, Karuna Therapeutics, Mapi Pharmaceuticals LTD, Merck, Mitsubishi Tanabe Pharma Holdings, Opko Biologics,Prothena Biosciences, Novartis, Regeneron, Sanofi-Aventis, Reata Pharmaceuticals, Teva Pharmaceuticals, NHLBI (Protocol Review Committee), University of Texas Southwestern, University of Pennsylvania, Visioneering Technologies, Inc., Employee of: Dr. Cutter is employed by the University of Alabama at Birmingham and President of Pythagoras, Inc. a private consulting company located in Birmingham AL., John Osborne: None declared, Kenneth Saag Grant/research support from: Amgen, Horizon, LG Chem, Radius, SOBI, Maria Danila Consultant of: UCB, Grant/research support from: Pfizer.